SCOTT BERINATO: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Scott Berinato. Over the past decade, pink has become a universally recognized symbol of breast cancer research. It is one of the strongest brands not just in the nonprofit world but in all marketing. But what if the color pink is actually counterproductive to the cause it represents? I’m joined today by Stefano Puntoni from the Rotterdam School of Management who’s uncovered evidence that the color pink and other identifiable gender cues make women less likely to think they’ll contract these diseases, and less likely to donate to research. Stefano, thank you for joining us.

STEFANO PUNTONI: Thank you.

SCOTT BERINATO: So tell us a little bit about your research and what you were setting out to accomplish when you looked at the relationship between gender cues and these diseases that women may contract.

STEFANO PUNTONI: So this is a topic that I’ve been working on for a number of years now. I actually started when I was still a BSc student in 2003. The work that I’ve been doing was done together with my BSc adviser, Nader Tavassoli from London Business School, and a colleague from INSEAD, Steven Sweldens. And what we were starting out from was this notion that for a lot of diseases, and breast cancer is only one of them, some aspects of one’s identity are quite important to the extent that they do tap into some antecedents of the disease. So you can imagine that gender is a strong predictor of whether you have any chance of contracting breast cancer. Or of contracting prostate cancer, for example. Or whether you a smoker is a strong predictor of whether you’re likely to contract lung cancer.

And we thought that perhaps there might be something interesting to look at in terms of the impact of, let’s say, accessibility or how top of mind that political identity is for one person at a given time. Because we know from a lot of research in psychology that the salience or relative importance of these identities fluctuates over time for any given individual. So let’s say that if I’m at home playing with my kids, the identity of father might be particularly activated. If I am here talking about my research, my identity as a researcher is particularly activated. And there are a lot of situational elements and contextual cues which may impact on this relative activation. So we thought that because some identities are related to some diseases that it might be something interesting to look at in terms of how this change in activation of the identity might in fact impact also thoughts and beliefs about the disease.

And something that we’re particularly interested in was the perceived vulnerability, the perceived risk that people have with regard to a particular disease. Because again, from a lot of psychological research, we know that you are likely to take some steps to try to prevent the consequences of a disease if you believe that there is a high risk related to the disease. You’re not going to do anything about a particular medical condition if your perception of that condition is that you’re not going to get it.

SCOTT BERINATO: So I was surprised to find that when you did your research, and maybe you were surprised to find too, that these gender cues actually made women feel less likely that they were going to contract the disease.

STEFANO PUNTONI: That’s exactly our sense of surprise. We were actually stunned by the findings. Because what we thought would happen is that if you make people feel more feminine, they would think that they are more likely to get breast cancer, because breast cancer is perceived as a gender disease. And therefore women who feel more feminine might believe that they are more similar to people who get the disease. Or simply they might think more about ideas related to breast cancer. Or they might feel a stronger sense of personal relevance. And we thought that that should lead to a greater effectiveness of this message.

As you add the more gender cues like more pink ribbons, more strong ties to gender like a slogan saying if you are a woman, you have to listen– stuff like that we thought would work to link the disease to women and make them think that they ought to pay attention or to do something about it.

But what has turned out to be the case is that in experiment after experiment, we kept on seeing that that was not the case. In fact, we saw that as you made females feel more feminine, they perceived to be less at risk for breast cancer, who wanted to make less money to gender specific diseases like ovarian cancer, to remember less advertisements for breast cancer, and so forth. So we really took our time to re-explore this phenomenon, because we couldn’t believe our eyes. But it kept on coming up. And now we’ve done it maybe 10 times or more, and it always happens.

SCOTT BERINATO: Stefano, what do you suppose is going on here? Because it does fly in the face of logic. What is actually happening when these gender cues are actually having the opposite effect of what we expect?

STEFANO PUNTONI: So the effect it a bit weird when you look at it the first time. But if you think about it more, actually it does make sense, insofar as it links to a lot of literature that explores what is called a defensive response to a threat. There’s a lot of literature, even going back to early psychoanalysts, that look at the fact that as we are confronted with a fact of some sort to essential dimension of the self, something that’s really important to us, that may many times trigger defensive responses. And there are many different types of defensive responses. But maybe the most obvious one would be denial. So you deny that something can happen because just admitting the possibility of that fact is just too threatening, and it hurts too much.

So these positions are not something that people can elaborate about. They are not conscious. They fly under the radar. People are not aware of them. And they, in the end, cause this effect. What that means basically is that as you make the breast cancer message very strongly tied to femininity, and as I said, you can do that in many ways, those gender cues end up triggering those defensive responses in female viewers or listeners because they tie the disease too strongly to themselves. And because women are so afraid of breast cancer, it’s really something that people find difficult to cope with in terms of both the likelihood and the outcomes, then basically these denial responses come up.

SCOTT BERINATO: I know you study lots of gender cues. I want to talk about one in particular, which is this color pink. Because the community of people who are involved in breast cancer research and support for breast cancer research have done an amazing job over the past decade or so of making pink their brand. And all of the marketing literature that you read in our magazine and elsewhere would suggest to you that a strong, identifiable brand is a good thing. So how do we reconcile this idea that this is a great brand that may not be doing what it’s supposed to be doing?

STEFANO PUNTONI: I totally agree with you that health care professionals and people involved in breast cancer communication have done an amazing job in the last decade or so in really bringing out to the public the message about the danger of breast cancer. And they did so by using a symbol. So they’ve really learned marketing. And I’m really happy to see that.

Now, first thing, I think it’s important to not go beyond the data. Because I wouldn’t like to really claim that pink is bad. What we observed is a combination of gender cues, of which pink might be one, when it ties message to a gender can create defensive responses. So we don’t actually have any study where we just changed pink into orange and we observed a defensive response. In some studies, we had advertising messages in which we changed a number of cues, and a lot of them were about pink. So let’s say the pink background with yellow a background, a pink ribbon with no ribbon.

But we also had a copy that emphasized you in the ad. For example, it said, hey woman, yes you, versus hey you. And the consequence is really the constellation of cues that we’ve observed that produced these defensive responses. Now, what is important to point out is that the cues that we used were, in fact, taken from real breast cancer ads, so it’s not like we’ve done something that cannot happen. In fact, I think health care professionals really need to know about these results and need to explore in their campaign, in their initiatives with pre-testing whether there is indeed a possibility that some of the gender cues, including pink, might in fact lead to bad outcomes. For example who are making people feel that they don’t need to worry about the disease or by making them forget about the message or not wanting to donate money to the cause and so on.

So I wouldn’t like just to ague that pink per se is bad. Pink per se is not bad. It is bad to the extent that contributes to a constellation of gender cues that can trigger defensive responses. Now a precise combination and level of intensity of the cues that can trigger these responses is something that we still need to know more about. We’re just scratching the surface to some extent by just providing evidence that this can happen and by providing evidence that it can happen in a surprisingly large number of contexts. But we have not conclusively demonstrated that pink is something that the breast cancer communication industry has to move away from.

SCOTT BERINATO: Now, this denial mechanism that I assume is unconscious, have you discovered any evidence that there are ways to overcome these gender cues or the response that they trigger? Are there things that, say, the breast cancer folks could do to overcome the denial response that people may be having to the branding?

STEFANO PUNTONI: So that’s a great question because, of course, from a practitioner point of view, what we care to know is what can we do about it, now that the effect has been established? So in a number studies, we have done some interventions that have been effective in eliminating these defensive responses. And we think that those interventions might have quite good parallels in the marketing world that people could use to design better copy, for example. And one of them is to present the message together with copy that makes women reflect about their fear of the disease.

To give you an example of a study that we run, we had women answering a question about the likelihood of them contracting breast cancer in the future. And we did so under two different conditions. Either they did that after writing a little essay about the role of gender in their life, or they did it after completing an essay about different personal characteristics that had nothing to do with gender. In this case, it was a location. And then half of the people completed that essay and then answered the risk question. Or before the risk question, they answered another question which is to think about how afraid they were about breast cancer.

And when people the fear question first, when we gave them an opportunity to voice their fear for the disease, then we did not observe any defensive responses. And this is what is consistent with a lot of literature in psychology that shows that a lot of these defensive or generally not conscious emotional influences on thoughts and behavior tend to disappear when you bring them out in the air, or in particular when you draw attention to them, they tend to go away. And the same happens here. So if you could imagine a context in which women are particularly aware or made to think about how afraid they are of breast cancer, then you don’t expect the pink cues and other cues to produce defensive reactions.

SCOTT BERINATO: Now there are gender cues for women, of course. But there are gender cues for men as well. And there are diseases associated with men, like prostate cancer. Did you find the same fact when you overloaded men with a constellation of male gender cues?

STEFANO PUNTONI: So we have not explored the male context as much as we have done with the females, because we were interested in breast cancer to start with. So that was our focus. But we did try to run a few studies focusing on men and prostate cancer. And there, we could not replicate the same neat pattern of results. It was actually a little bit all over the place. We still need to do more work on this. But what we’re thinking at the moment is that for these defensive reactions to occur when you make a related identity salient, some conditions have to be met. And they not always are met.

So to give an example, you need to have an identity that is very central to the self, otherwise you don’t have a big threat. And also, you have to have a threat that is very severe. And in the case of prostate cancer in males, note that our respondents were young men. And for them, probably, the notion of breast cancer is not nearly as threatening as it is for females, the notion of breast cancer. Because prostate cancer is not maybe as known as a disease, because it’s not killing as many people, even though it’s a very prevalent one. And because it affects only old man, basically, mostly. I mean, that’s not true. But by and large, it does. Whereas breast cancer has relatively high incidents among younger age groups as well, which makes it clearly something that younger women should be very aware of. So we think that simply in the case of prostate cancer and males, the conditions are not met to for these defensive reactions to occur reliably.

Now it would be interesting to study that context in more detail, for example, looking at older men. Or also to look at different medical conditions related to identity. And you could imagine some risks related to jobs, for example. what about risk of severe burns for firefighters, or something like that? I don’t know. We have explored these kind of settings. But certainly, I think, there would be a lot more research that can be done about it.

STEFANO PUNTONI: This is really a wonderful opportunity to communicate our issues to a very wide public. And I’m really grateful for it. Thank you very much.

SCOTT BERINATO: Stefano Puntoni is a Professor at the Rotterdam School of Management. This research can be found in the July/August issue of Harvard Business Review in the Defend Your Research section. You can also find it on hbr.org.